HPV高危型别检测联合细胞学检查对宫颈病变筛查的研究

The study of combining high-risk human papillomavirus types checking and cytologic test in the screening of cervical lesions

目的 研究人乳头瘤病毒HPV高危型别检测联合液基薄层细胞学检查（TCT）及阴道镜检查对宫颈癌及癌前病变筛查的诊断价值。方法 对1375例宫颈组织细胞样本进行HPV高危型别检测，对其中阳性样本进行TCT检查，有宫颈上皮内瘤变者（CIN）行阴道镜下活检病理组织学确诊。HPV高危型别检测采用双色荧光定量PCR方法进行8种高危型HPV DNA（主要高危型：HPV16，18，45,31）和次要高危型（HPV33，52，58，67）分型及病毒载量检测。结果 1375例样本高危型HPV DNA检测结果为阳性256例，阳性率为18.62％；TCT结果为WNL的样本高危型HPV的感染率为16.41％ （42/256）；TCT结果为ASCUS以上的样本高危型HPV的感染率为83.59％（ 214/256）。HPV各型别的病毒载量在TCT结果为WNL、ASCUS及LSIL/HSIL/SCC之间差异无统计学意义（P＞0.5）。TCT与阴道镜的阳性符合率分别为WNL-正常或炎症92.86％（ 39/42），LISL-CIN I 81.36％（48/59），HSIL-CIN Ⅱ＆Ⅲ 85.19％ （23/27），SCC-宫颈癌9/10。结论 HPV高危型别检测联合TCT技术及阴道镜检查能显著提高宫颈病变的阳性检出率，可作为宫颈癌及宫颈上皮内瘤变（ CIN）筛查的可靠早期诊断方法，具有重要临床应用价值。

Objective To study the relationship between thinprep cytologic test and the types of human papilloma virus （HPV） infection in cervical precancerous lesion screening. Methods To perform high-risk HPV types test in 1375 samples. Choose 256 positive samples to take thinprep cytologic test （TCT） and directed biopsies under colposcopy. Adopting two-channels real time PCR to genotype and quantify eight high risk HPV DNA （high risk types： HPV 16,18,45,31 ; intermediate risk types： HPV 33,52,58,67）. Results There are 256 positive samples in High risk HPV DNA test （ 18. 62% ）. WNL rate for TCT is 16.41% （42/256）, ASCUS and above rate for TCT is 83.59% （214/256）. There is no statistically significant difference in the viral loads of HPV infection rate between the TCT negative patients and positive patients （ P 〉 0. 5 ）. Positive correspondence rate for TCT and biopsy are 92. 86% （ 39/42）,81.36% （48/59） ,85.19% （23/27）and 9/10. Conclusion High-risk HPV types checking combined with TCT and biopsy can raise positive rate significantly. It should be used as a reliable method for early diagnosis in cervical cancer and CIN screening.